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Volume 2024, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Functional adrenal tumors may contribute to poor hypertension control and electrolyte abnormalities, thus increasing the risk of cardiovascular mortality. Currently, laparoscopic adrenalectomy is an effective surgical option that contributes to improved treatment outcomes as compared to open surgery. The purpose of this study was to evaluate the outcomes of laparoscopic adrenalectomy performed by a general surgeon at a low-volume center and to identify clinicopathological risk factors for postoperative persistent hypertension.

Methods: A retrospective study of patients with functional adrenal tumors who underwent laparoscopic adrenalectomy at Srinakharinwirot University, Thailand, between 2014 and 2022. Clinicopathologic and postoperative data were examined.

Results: This study included twenty-five patients; the indications for laparoscopic adrenalectomy included primary aldosteronism in 19 (76%), pheochromocytoma in 4 (16%), and Cushing’s syndrome in 2 (8%). The average time of surgery was 103.5 ± 19.7 min, and intraoperative complications occurred in three patients (12%), with one patient requiring conversion to open surgery (4%). The postoperative systolic (125 ± 15 vs. 158 ± 18 mmHg; < 0.001) and diastolic (78.5 ± 6.7 vs. 95.3 ± 10 mmHg; = 0.013) blood pressure significantly decreased compared to prior surgery, but only 19 patients (76%) achieved a cure for hypertension. Multivariate analysis revealed that the patient’s physical status, as classified by the American Society of Anesthesiologists (odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.43–1.32, = 0.001), and the need for at least three antihypertensive medicines (OR = 0.7, 95% CI 0.36–1.2, = 0.002), were independent predictive factors of persistent hypertension after surgery.

Conclusion: Laparoscopic adrenalectomy is a safe and effective surgical treatment for functional adrenal tumors, even when performed in a low-volume center. According to the American Society of Anesthesiologists’ physical categorization, the patient’s physical condition and the necessity for at least three antihypertensive medications are predictors of postoperative hypertension.

Trial registration: The study was registered with the Thai Clinical Registry Trials: TCTR20230707007.

© 2024 Tullavardhana, Licensee HBKU Press.
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2024-08-08
2025-01-23
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References

  1. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Ali A, et al.. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000; 85:(2):637–44. doi: 10.1210/jcem.85.2.6372
     [Google Scholar]
  2. Cawood TJ, Hunt PJ, Shea O, Cole D, Soule D. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant, time for a rethink? Eur J Endocrinol. 2009; 161:(4):513–27. doi: 10.1530/EJE-09-0234
     [Google Scholar]
  3. Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005; 366:(9486):665–75. doi: 10.1016/s0140-6736(05)67139-5
     [Google Scholar]
  4. Bravo EL, Tagle R. Pheochromocytoma: State-of-the-art and future prospects. Endocr Rev. 2003; 24:(4):539–53. doi: 10.1210/er.2002-0013
     [Google Scholar]
  5. Grumbach MM, Biller BMK, Braunstein GD, Campbell KK, Carney JA, Godley PA, et al.. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003; 138:(5):424–9. doi: 10.7326/0003-4819-138-5-200303040-00013
     [Google Scholar]
  6. Piaditis GP, Kaltsas GA, Androulakis II, Gouli A, Makras P, Papadogias D, et al.. High prevalence of autonomous cortisol and aldosterone secretion from adrenal adenomas. Clin Endocrinol (Oxf). 2009; 71:(6):772–8. doi: 10.1111/j.1365-2265.2009.03551.x
     [Google Scholar]
  7. Vaidya A, Mulatero P, Baudrand R, Adler GK. The expanding spectrum of primary aldosteronism: Implications for diagnosis, pathogenesis, and treatment. Endocr Rev. 2018; 39:(6):1057–88. doi: 10.1210/er.2018-00139
     [Google Scholar]
  8. Km A-O. Laparoscopic adrenalectomy: 10 years experience. Urol Ann. 2012; 4:(2):94–7. doi: 10.4103/0974-7796.95553
     [Google Scholar]
  9. Aporowicz M, Domosławski P, Czopnik P, Sutkowski K, Kaliszewski K. Perioperative complications of adrenalectomy—12 years of experience from a single center/teaching hospital and literature review. Arch Med Sci. 2018; 14:(5):1010–9. doi: 10.5114/aoms.2018.77257
     [Google Scholar]
  10. Machado NO, Al Qadhi H, Al Wahaibi K, Rizvi SG. Laparoscopic adrenalectomy for large adrenocortical carcinoma. JSLS. 2015; 19:(3):e2015.00036. doi: 10.4293/JSLS.2015.00036
     [Google Scholar]
  11. Tullavardhana T. Primary hyperaldosteronism: The role of the general surgeons in diagnosis and treatment. In: Pãun DL, Cianci P, Restini E, editors. Adrenal glands—The current stage and new perspectives of diseases and treatment. London:IntechOpen;2024. doi: 10.5772/intechopen.107460
     [Google Scholar]
  12. Kwak J, Lee KE. Minimally invasive adrenal surgery. Endocrinol Metab (Seoul). 2020; 35:(4):774–83. doi: 10.3803/EnM.2020.404
     [Google Scholar]
  13. Nomine-Criqui C, Demarquet L, Schweitzer ML, Klein M, Brunaud L, Bihain F. Robotic adrenalectomy: When and how? Gland Surg. 2020; 9:S166–72. doi: 10.21037/gs.2019.12.11
     [Google Scholar]
  14. Liu Z, Li D-W, Yan L, Xu Z-H, Gu G-L. Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. BMC Surg. 2021; 21:(1):432. doi: 10.1186/s12893-021-01422-w
     [Google Scholar]
  15. Ottlakan A, Paszt A, Simonka Z, Abraham S, Borda B, Vas M, et al.. Laparoscopic transperitoneal and retroperitoneal adrenalectomy: A 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]. Surg Endosc. 2020; 34:(12):5421–7. doi: 10.1007/s00464-019-07337-1
     [Google Scholar]
  16. Pang TC, Bambach C, Monaghan JC, Sidhu SB, Bune A, Delbridge LW, et al.. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg. 2007; 77:(9):768–73. doi: 10.1111/j.1445-2197.2007.04225.x
     [Google Scholar]
  17. Zhou Y, Zhang M, Ke S, Liu L. Hypertension outcomes of adrenalectomy in patients with primary aldosteronism: A systematic review and meta-analysis. BMC Endocr Disord. 2017; 17:(1):61. doi: 10.1186/s12902-017-0209-z
     [Google Scholar]
  18. Conzo G, Pasquali D, Gambardella C, Della Pietra C, Esposito D, Napolitano S, et al.. Long-term outcomes of laparoscopic adrenalectomy for Cushing disease. Int J Surg. 2014; 12:(Suppl. 1):S107–11. doi: 10.1016/j.ijsu.2014.05.036
     [Google Scholar]
  19. Pogorzelski R, Toutounchi S, Krajewska E, Fiszer P, Łykowski M, Zapała Ł. The effect of surgical treatment of phaeochromocytoma on concomitant arteri al hypertension and diabetes mellitus in a single-centre retrospective study. Cent Eur J Urol. 2014; 67:(4):361–5. doi: 10.5173/ceju.2014.04.art9
     [Google Scholar]
  20. Rubio-Guerra AF, Castro-Serna D, Barrera CIE, Ramos-Brizuela LM. Current concepts in combination therapy for the treatment of hypertension: Combined calcium channel blockers and RAAS inhibitors. Integr Blood Press Control. 2009; 2:55–62. doi: 10.2147/ibpc.s6232
     [Google Scholar]
  21. Marinier K, Macouillard P, de Champvallins M, Deltour N, Poulter N, Mancia G. Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink. Pharmacoepidemiol Drug Saf. 2019; 28:(12):1572–82. doi: 10.1002/pds.4884
     [Google Scholar]
  22. Burnier M, Wuerzner G. Ambulatory blood pressure and adherence monitoring: Diagnosing pseudoresistant hypertension. Semin Nephrol. 2014; 34:(5):498–505. doi: 10.1016/j.semnephrol.2014.08.003
     [Google Scholar]
  23. Smith SM, Gong Y, Handberg E, Messerli FH, Bakris GL, Ahmed A, et al.. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension. J Hypertens. 2014; 32:(3):635–43. doi: 10.1097/HJH.0000000000000051
     [Google Scholar]
  24. Goh BKP, Tan Y-H, Yip SKH, Eng PHK, Cheng CWS. Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism. JSLS. 2004; 8:(4):320–5.
    [Google Scholar]
  25. Celen O, O’Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism. Arch Surg. 1996; 131:(6):646–50. doi: 10.1001/archsurg.1996.01430180072015
     [Google Scholar]
  26. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al.. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: A systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018; 6:(1):41–50. doi: 10.1016/S2213-8587(17)30319-4
     [Google Scholar]
/content/journals/10.5339/qmj.2024.30
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Laparoscopic adrenalectomy performed by a general surgeon on functioning adrenal tumors: Treatment outcomes and risk prediction of persistent hypertension
Qatar Medical Journal 2024, 30 (2024); https://doi.org/10.5339/qmj.2024.30
/content/journals/10.5339/qmj.2024.30
/content/journals/10.5339/qmj.2024.30
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  • Article Type: Research Article
Keyword(s): Adrenal cortical adenoma, adrenal gland diseases, adrenalectomy, hypertension and laparoscopic surgery

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